NCG030597_Renewal COC Request_20181203 10:36:17 AM

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NORTH CAFOLINA
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Permit COC
NCG030597
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Gary Graybeal
Obtaining COC*
First and LastNarre
Phone Number* [phone]
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email address to whom to send the CDC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
M aste r Ge ne ral
NCG030000
Permit No.
COC No.
NCG030597
Permittee
Halcore Group Inc -American Emergency
Vehicles Inc
Facility Name
American Emergency Vehicles, Inc.
Address
165 American Way
City
Jefferson
County
Ashe
Waterbody
Naked Creek
Classification
C:+
River Basin
New
RENEWAL STATUS
Active
Issuance Date *
10/29/2018
Effective Date
11/01/2018
1 hereby request a copy of the Certificate of Coverage (COC) entered above. I understand that the COC e-mailed as a
result of this request will serve as the Permittee's record of renewed coverage under the General Permit, and that this
record must be maintained with the Permittee's NPDES Stormwater Permit records.
Signature *
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Date * 12/03/2018